Form Attachment H Attachment H Business Classification REport

Bureau of Labor Statistics

U.S. Department of Labor

O.M.B. No. 1220-0141

Expires April 30, 2018

Business Classification Report

Please complete and return this form by MMMM DD, YYYY.

1

What is your contact information?

Please provide contact information for the person who completed this form.

Name:
Title:						Business website:
Phone:	( )					E-mail:

2

If the address below is not correct, please enter the updated address in the space provided.

		Enter Address Corrections for Physical Location Below
[FILL COMPANY NAME]
[FILL ADDRESS 1]
[FILL ADDRESS 2]
[CITY, STATE,ZIP]
[RUN_DESC]

3

Does the worksite listed in Question 2:

a

Manufacture any products or produce any goods?

• Yes

• 

  b

  No

Arrange for any products or goods to be manufactured outside the U.S.?

• Yes

• 

  c

  No

Arrange for any products or goods to be manufactured inside the U.S. by an independent manufacturer?

• Yes

• No

4

If you have any comments about this report, please note them here:

Thank you for completing this report. Please return it using the self-addressed, stamped envelope.

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